Provocative Manometric Discography
A discography, also called a discogram or diskogram, is a diagnostic procedure sometimes used to identify damaged cushioning discs (intervertebral discs) between the bones of your spine. You can develop disc damage in your cervical spine (neck), thoracic spine (upper back) or lumbar spine (lower back).
Intervertebral Disc Basics
Each intervertebral disc contains a soft center, or nucleus, surrounded by a tough outer covering called the annulus, which keeps the nucleus in place and maintains the overall shape of the disc. You rely on these discs to absorb the shock and wear and tear associated with everyday activities, as well as the trauma associated stronger spinal impacts. The intervertebral discs also help your back maintain its normal flexibility. Damage to these discs can come from sources that include age-related loss of water in the nucleus, arthritis or other degenerative disorders in your spinal bones, accidents, injuries and hereditary back disorders. The most well-known problem associated with them is a shifting or leakage of the nucleus material called a herniated disc.
Patients who undergo a discography remain awake. At the start of the procedure, your doctor will use live X-rays and a body scan called a computed tomography (CT) scan to get a clear image of your spine and its intervertebral discs. He will then locate the discs that are suspected of causing your problems and inject them with a substance called a contrast dye. In addition to making structural flaws in a disc easier to see, this dye can recreate the pain that’s responsible for your disc-related symptoms. As he injects a disc, your doctor will ask you evaluate any pain that occurs, based on characteristics such as its severity and specific location. Depending on the number of discs under evaluation, a discography can take anywhere from half an hour to an hour.
Overall, discography gives doctors a highly effective method for obtaining an accurate picture of discs in your back that may be responsible for pain and other symptoms. It also gives doctors an effective way to recreate disc pain and confirm the presence of these symptoms. Discography probably provides the clearest benefit for people with problem discs in their lumbar spine. There is somewhat less evidence for the benefit of discography in people with problem discs in their cervical spine. Doctors don’t have much evidence for the benefits of the procedure in people with problems in their thoracic spine.
While discography presents little overall risk to your health, you can potentially develop complications that include intensification of your existing back pain, an allergic reaction to the contrast dye, nausea, headaches, bleeding, short-term weakness, short-term numbness, an infection between your discs and spinal bones, nerve or blood vessel damage associated with your spine, and paralysis. Certain people may have additional health complications when undergoing the procedure, including asthmatics, diabetics, pregnant or nursing women, people with thyroid problems, people with heart or kidney problems, people who take anticoagulant medications and people with known allergies to things such as iodine injections, shellfish and medications.
Radiological Society of North America/American College of Radiology: Discogram
Mayo Clinic: Discogram (Pages 1-6)
Cedars-Sinai: Spinal Diagnostics – Discography
Mayfield Clinic for Brain & Spine: Discogram
“Pain Physician”: Systematic Review of Discography as a Diagnostic Test for Spinal Pain – An Update
“Pain Physician”: Systematic Review of Thoracic Discography as a Diagnostic Test for Chronic Spinal Pain